Comparing Outcomes Between Robotic Assisted versus Manual Percutaneous Coronary Intervention-A Meta-Analysis of 2,203 Patients

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Introduction: Robotics in percutaneous coronary intervention (R-PCI) has been one such area of advancement where potential benefits may include reduction in radiation exposure, improved outcomes and reduced rate of adverse events. Robotic assistance may offer many potential benefits to both the operator and the patient. Limited data exist about the benefits of R-PCI vs. conventional manual PCI (M-PCI).

Hypothesis: The aim for our meta-analysis is to evaluate the procedural measures and clinical outcomes between R-PCI and M-PCI.

Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant clinical studies. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. All studies adhering to the inclusion criteria of direct comparisons between R-PCI and M-PCI were evaluated.

Results: Seven studies with a total of 2,230 patients were identified. There was significant decrease in the chest-level operator radiation exposure (OR= -442.32; 95% CI = -675.88 to -208.76), fluoroscopy time (OR = -1.46; 95% CI -2.92 to 0.00) and amount of contrast used (OR= -18.28; 95% CI -24.16 to -12.41) in the robotic group as compared to the manual group. PCI time (OR = 2.41; 95% CI -3.95 to 8.76) and procedural success rate (OR 1.26; CI 0.19-8.22) was not statistically different between the two groups. In terms of clinical outcomes, there was no difference between R-PCI and M-PCI in terms of major adverse cardiac events (OR 0.90; CI 0.45-1.79), all-cause mortality (OR 0.95; CI 0.21-4.30), and myocardial infarction (OR 0.88; CI 0.41-1.89).

Conclusions: Robotic PCI is associated with reduced operator radiation exposure, fluoroscopy time and amount of contrast used. While there is a significant reduction in the procedural characteristics with robotic PCI, the clinical outcomes are not different compared to manual PCI. Use of robotics in PCI appears to be safe and potentially favorable to the patients, in addition to its benefits of improved ergonomics. More randomized studies looking at the use of R-PCI, especially in complex lesions, are needed before consideration for widespread implementation.